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Health Facilities and Services Review Board STATE OF ILLINOIS HEALTH FACILITIES AND SERVICES REVIEW BOARD 525 WEST JEFFERSON ST. • SPRINGFIELD, ILLINOIS 62761 •(217) 782-3516 FAX: (217) 785-4111 DOCKET NO: BOARD MEETING: PROJECT NO: September 14, 2021 21-016 PROJECT COST: H-04 FACILITY NAME: CITY: Original: $170,520,604 NorthShore Glenbrook Hospital Glenview TYPE OF PROJECT: Substantive HSA: VII PROJECT DESCRIPTION: The Applicant [NorthShore University HealthSystem] is asking the State Board approve establishment of an open-heart surgery category of service, the addition of 8 cardiac cath labs, and the addition of 6 surgery rooms at Glenbrook Hospital in Glenview, Illinois. The cost of the project is $170,520,604. The expected completion date is December 31, 2024. The purpose of the Illinois Health Facilities Planning Act is to establish a procedure (1) which requires a person establishing, constructing or modifying a health care facility, as herein defined, to have the qualifications, background, character and financial resources to adequately provide a proper service for the community; (2) that promotes the orderly and economic development of health care facilities in the State of Illinois that avoids unnecessary duplication of such facilities; and (3) that promotes planning for and development of health care facilities needed for comprehensive health care especially in areas where the health planning process has identified unmet needs. Cost containment and support for safety net services must continue to be central tenets of the Certificate of Need process. (20 ILCS 3960/2) The Certificate of Need process required under this Act is designed to restrain rising health care costs by preventing unnecessary construction or modification of health care facilities. The Board must assure that the establishment, construction, or modification of a health care facility or the acquisition of major medical equipment is consistent with the public interest and that the proposed project is consistent with the orderly and economic development or acquisition of those facilities and equipment and is in accord with the standards, criteria, or plans of need adopted and approved by the Board. Board decisions regarding the construction of health care facilities must consider capacity, quality, value, and equity Information regarding this Application for Permit can be found at https://www2.illinois.gov/sites/hfsrb/Projects/Pages/NorthShore-Glenbrook-Hospital,-Glenview--21- 016.aspx ILLINOIS HEALTH FACILITIES AND SERVICES REVIEW BOARD EXECUTIVE SUMMARY PROJECT DESCRIPTION: • The Applicant [NorthShore University HealthSystem] is asking the State Board to approve the establishment of an open-heart category of service, the addition of 8 cardiac cath labs, 6 surgery rooms, 19 Phase I and 31 Phase II PACU rooms at Glenbrook Hospital in Glenview, Illinois. The cost of the project is $170,520,604. The expected completion date is December 31, 2024. • The Applicant is consolidating most of the open heart and vascular surgical services and cardiac catheterization services at Glenbrook Hospital at the Cardiovascular Institute on the Glenbrook Hospital campus. The Applicant states this project encompasses cardiac services at four hospitals: Evanston Hospital, Highland Park Hospital, Skokie Hospital as well as Glenbrook Hospital. 1 The Table below outlines the Hospitals involved in this project and their 2019 utilization. TABLE ONE Executive Summary 2019 Information # of Surgery # Rooms # Open # Cardiac Cardiac Hospital City Time Miles Dedicated Heart Cath Cath. to Surgeries Procedures Labs Cardiovascular Glenbrook Hospital Glenview 0 0 0 0 1 331 Skokie Hospital Skokie 21 8.1 0 0 2 196 Evanston Hospital Evanston 27 10.5 2 178 3 3,404 Highland Park Highland Park 23 11.7 1 117 2 1,956 Hospital Total 3 295 8 5,887 • At the conclusion of this project cardiac catheterization services will remain at Evanston Hospital and Highland Park Hospital. In addition, open heart surgery will remain at Highland Park Hospital- even though the projected number of open-heart surgeries at Highland Park is estimated by the Applicant to be less than the State Board Standard of 200 surgeries per year. In conjunction with this project Skokie Hospital discontinued their cardiac catheterization category of service [#E-014- 21] and Evanston Hospital will discontinue their open-heart surgery category of service at the conclusion of this project.2 1 NorthShore University HealthSystem’s Northwest Community Hospital and Swedish Hospital will not discontinue their open-heart programs. According to the Applicant some advanced cardiovascular procedures may be referred from these two Hospitals to Glenbrook Hospital. The Applicant states it is anticipated that NorthShore Evanston Hospital and NorthShore Highland Park Hospital will maintain emergency cardiovascular care capabilities, specifically as it relates to patients presenting with an acute ST elevation myocardial infarction or need for emergent pacemaker implantation. It is estimated that for cardiac surgery cases, this will likely be in the order of approximately 1 to 1.5 cases per week or 50 to 75 per year. 2 Evanston Hospital will maintain one cardiac cath lab for emergent cath and EP cases. Its other two labs will be repurposed for interventional radiology procedures. Highland Park Hospital will maintain one cardiac cath lab for emergent cath and EP cases. Its other lab will be repurposed for interventional radiology procedures. Skokie Hospital closed its two cath labs, effective August 1, 2021. Page 2 of 30 WHY THE PROJECT IS BEFORE THE STATE BOARD: • This project is before the State Board because the project proposes to establish a category of service and the project is more than the capital expenditure minimum $14,557,713. PUBLIC HEARING/COMMENT: • No public hearing was requested. Letters of support were received by the State Board. No letters of opposition were received by the State Board. SUMMARY: • For an Applicant to establish an open heart surgery program an Applicant must document that a minimum of 200 open heart surgical procedures will be performed during the second year of operation or that 750 cardiac catheterizations were performed in the latest 12-month period for which data is available. To add cardiac catheterization labs the Applicant must demonstrate 400 cardiac catheterization procedures will be performed per lab and all cardiac catheterization programs in the Cardiac Catheterization Planning Area are operating at 400+ procedures per year. To add operating rooms to an existing hospital the hospital must demonstrate historical utilization [hours] will justify the proposed number of operating rooms being requested. • Open Heart: The Applicant is estimating 260 open-heart surgeries will be performed within two years after project completion. As seen in the Table above there were 295 open-heart surgeries performed in 2019 at Evanston and Highland Park Hospitals. The two Hospitals have experienced a 3% decline in the number of open-heart surgeries for the period 2015-2019. The estimate of 260 open-heart surgeries by 2026 is reasonable and takes into consideration the decline in open heart surgeries. Given the number of open-heart surgeries performed at Evanston and Highland Park Hospitals in 2019 of 295 surgeries meets the State Board Standard of 200 open-heart surgeries to establish the service. No hospital within a 20-mile radius with an open-heart surgery program has submitted an impact letter contesting the establishment of the open-heart surgery program at Glenbrook Hospital. Average case time for open heart surgeries was estimated by the Applicant as 8-10 hours per procedure. • Vascular Surgery: The Applicant has stated 752 vascular surgeries were performed in 2019 and are estimating a 33.1% increase in these cases by the second year after project completion [2026]. Total vascular cases estimated by 2026 is 1,001 cases with an average case time of 4 hours. The Applicant is proposing 3 operating rooms for these surgeries. • Cardiac Catherization: The Applicant is estimating 5,387 cardiac catheterizations to be performed at the Glenbrook Hospital by 2026. For the period 2015-2019 there has been a growth of 6.2% annually in the number of cardiac catheterization procedures performed at Evanston, Glenbrook, Highland Park, and Skokie Hospitals. The 5,387 cardiac cath procedures will justify the nine cardiac cath labs being requested at the Board’s standard of 400 cardiac catheterizations per lab. • Surgery Rooms: The Applicant is requesting to add 6 operating rooms for a total of 14 operating rooms: 3 operating rooms dedicated to open-heart surgery and 3 operating rooms dedicated for vascular surgery. Average case time for the period 2015-2019 at Evanston and Highland Park Hospitals for the dedicated cardiovascular operating rooms was 4.07 hours per case. Based upon that case time the Applicant cannot justify the six operating rooms being requested. • The Applicant addressed a total of 25 criteria and have not met the following: Page 3 of 30 State Board Standards Not Met Criteria Reasons for Non-Compliance 77 ILAC 1110.120 (b) – Projected Utilization • Projected Utilization: This finding relates to the 77 ILAC 1110.270 (c) – Service Modernization - Applicant stating the 3 operating rooms for open Surgery heart surgery are justified based upon the average case time of 8-10 hours per procedure. Board Staff was unable to accept a case time of that amount without an explanation. The Applicant stated a physician or physicians would provide an explanation at the Board Meeting. Average cardio surgery case time at Highland Park and Evanston Hospitals was 4.07 hours for cardio surgeries performed at these two hospitals for the period 2015- 2019. Using that case time of 4.07 hours and applying that number to the number of open heart and vascular surgeries estimated to be performed by the Applicant justifies 4 operating rooms and not the 6 operating rooms being requested. • Service Modernization: The average surgery hours at Glenbrook Hospital for 2018-2019 support the need for 11 operating rooms and not the 14 rooms being requested.
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